PSRB Annual Performance Progress Report

LFO Revised Budget Form #107BF04c

Psychiatric Security Review Board
Annual Performance Progress Report (APPR)
for Fiscal Year 2005-06

Original Submission Date: March 16, 2007

2005-07 KPM# 2005-07 Key Performance Measures (KPMs) Page #
01 RECIDIVISM RATE – % of revocations of conditional release based on commission of felony 4
02 TIMLINESS OF HEARINGS – % of hearings scheduled within statutory timeframes 6
03 MAINTENANCE OF RELEASED CLIENTS – % of conditional releases maintained in the community per month 8
04 CUSTOMER SERVICE – % of customers rating their satisfaction with the agency’s customer service as “good” or “excellent”; overall customer service, timeliness, accuracy, helpfulness, expertise and availability of information. 10

Contact: Mary Claire Buckley, J.D., Executive Director Phone: (503) 229-5596
Alternate: Phone:

1. SCOPE OF REPORT
• The Psychiatric Security Review Board is consolidated into one program that effectively provides statutorily required hearings for adult clients and close supervision of those on conditional release in the community. Although a juvenile panel of the Board became effective January 1, 2007, the enabling statutes do not provide for the receipt of juvenile clients until July 1, 2007. Thus none of the current measures relate to any activity of the juvenile panel. However, performance measures specific to the operations of the juvenile panel will be developed and tracked for future reporting.

• The two aspects of the Board’s program, hearings and monitoring, are addressed by the four reported performance measures.

2. THE OREGON CONTEXT
As the State’s population continues to grow, so does the number of persons who require mental health services. When the demand for behavioral health services increases, but those necessary community services are reduced or eliminated or are not accessed for whatever reason, persons who are unsuccessful in managing their mental illness and unable to obtain needed help come to the attention of law enforcement personnel. In Oregon, the number of persons with mental health diagnoses involved in the criminal justice system has grown significantly as evidenced by the numbers housed in local jails and Department of Corrections’ institutions. Once charged with a crime, historically a small percent of defendants opt for the insanity defense and, usually by stipulation, are placed under the Psychiatric Security Review Board which is a national model for the management and treatment of insanity clients. In fulfilling its mandate the Board’s primary purpose is to protect the public. Thus it serves a critical societal need and contributes to the high-level outcome measure #64 of the Oregon Benchmarks – Adult Recidivism. Its work necessarily requires collaboration with a number of partners in both the criminal justice and mental health systems, including judges, district attorneys and defense attorneys as well as DHS’s Addictions and Mental Health Division and Seniors and Persons with Disabilities Division, Oregon State Hospital, local mental health authorities, county and community mental health agencies and other treatment and residential providers.

3. PERFORMANCE SUMMARY
The summary chart indicates that the Board is making progress on two measures; not making progress on one; and it is unclear on the remaining measure.
More specifically, the Board is making good progress in meeting or exceeding its target on two of its critical measures. However, the other long-standing measure regarding timeliness reflects a very concerning and disappointing result. Not only did the Board not make progress in this arena, but it took a serious nose dive.
Finally, it is too soon to gauge the Board’s progress in customer satisfaction as this is a new measure with results reported for the first time in 2006. However, the initial scores indicated areas that will need improvement.

4. CHALLENGES
Currently the Board is facing an unprecedented growth in the number of hearings it must hold. The Board projects a need for approximately 1000 hearings in the ’07-’09 biennium. Thus improving the timeliness of hearings despite the tremendous increase in demand for hearings will be the biggest performance challenge the Board faces in the next biennium. The reason is twofold: there is a limit to the number of hearings that members can realistically handle per hearing day and secondly, the Board is reliant on others including its clients’ psychiatrists and other treatment providers, be it those at Oregon State Hospital or in the community, to present the information required by the Board in a timely fashion so that Board initiated continuances are not necessary.

5. RESOURCES USED AND EFFICIENCY
The Board’s budget amount for the fiscal year, measured as one-half of its Legislatively adopted expenditure limitation is $424,732. The reported measure that reflects efficiency is #02, the percentage of hearings scheduled within statutory timelines. The Board also keeps two other efficiency measures for internal tracking and management use.

KPM #01 RECIDIVISM RATE –
% of revocations of conditional release based on commission of felony Measure since: 1992
Goal To protect the public
Oregon Context #64 – Recidivism Rate

Data source Agency records – affidavits in support of revocation order which outline reason for revocation. Done quarterly.
Owner Mary Claire Buckley, J.D., Executive Director – (503) 229-5596

1. OUR STRATEGY

The Board’s strategy is to maintain public safety by engaging in effective decision-making regarding appropriate placement of its clients and the subsequent monitoring of those living in the community. Its partners in this endeavor include DHS’ Addictions and Mental Health Division; Oregon State Hospital and a host of community agencies and treatment providers.

2. ABOUT THE TARGETS

The Board originally set its target at 0% based on its statutory mandate. However, after discussion with the Progress Board, it realized that that may have been a worthy goal but was unrealistic given this population so the target was adjusted. The target increased each year due to the anticipated rise in the number of clients that would be conditionally released in the community. Clearly the lower the actual percent, the better as the safer the community is. In 2005, the Board exceeded its target with a perfect rate of 0% for that calendar year. For 2006, its actual rate rose slightly based on one felony offense out of 54 revocations but still bested its target.

3. HOW WE ARE DOING

In 2006, the Board’s recidivism rate was 1.9%. This measure was below target as was the case in 2005. The general trend shows a continuance of positive performance in this arena.

4. HOW WE COMPARE

The Psychiatric Security Review Board is a unique model for the management and treatment of those who successfully assert the insanity defense. There are no public or private industry standards for this population. The State of Connecticut estabished a system modelled after, but not identical, to Oregon’s. It reports a rate of 0% although they have very few clients on conditional release in comparison – 22 of 161 vs. 351 of 726.
The Board would cite the Department of Corrections’ recidivism rate which is approximately 30% as the closest comparison to an agency in Oregon.

5. FACTORS AFFECTING RESULTS

Although it is the Board’s responsibility to make informed and effective decisions regarding the readiness of a client to return to live in the community without further violations of the law, it is extremely dependent on Oregon State Hospital staff to provide complete and accurate information on which to base those determinations. Further it has to provide the client the treatment and skills necessary to be successful in a community setting. In addition, the community agency must provide the structure, support and supervision necessary for a client’s successful reintegration.

6. WHAT NEEDS TO BE DONE

The Board and staff need to continue their successful efforts to assure public safety by demanding adequate and accurate information from Oregon State Hospital staff and community treatment teams on which they can base these critical decisions.

7. ABOUT THE DATA

The reporting cycle is based on a calendar year. However, the data is collected and tallied on a quarterly basis from the revocation orders issued by the Board. Any individual who commits a new felony offense while on conditional release would be automatically revoked. This information is highly reliable as an affidavit is required for each revocation which sets forth the reason for the revocation warrant.

KPM #02 TIMELINESS OF HEARINGS –
% of hearings scheduled within statutory timelines Measure since: 1992
Goal To review client’s progress in a timely manner and protect clients’ due process rights.
Oregon Context KPM #4 – Timeliness and Agency Mission

Data source Agency records – hearing dockets and client files with pertinent dates
Owner Mary Claire Buckley, J.D., Executive Director – (503) 229-5596

1. OUR STRATEGY

The Board’s intent is to set each client’s hearing within the required timelines set by statute. Staff maintain a running calendar outlining when each PSRB client’s particular hearing is due which is utilized to set the weekly Board docket.

2. ABOUT THE TARGETS

The Board adjusted this target as well because its original goal was far too ambitious given the reality of the hearing schedule. The Board reduced it to what was thought to be a more reasonable figure. In this situation, the higher the percent, the better the Board has done.

3. HOW WE ARE DOING

In 2006, the percentage of hearings held in the statutorily-mandated timeframes was 74%. This figure is woefully below the target and evidences a serious decline in this actual measure from previous years which were close to or better than the target.

4. HOW WE COMPARE

Once again, given the unique nature of the PSRB and its operations, the Board is not aware of any comparable public or private industry standards.
5. FACTORS AFFECTING RESULTS

The Board’s more recent targets reflect the fact that there will always be a small number of hearings that cannot be held in a timely fashion. However, that number is a far cry from the 26% that is indicated in 2006. The major factor contributing to this significant decline was the new Board’s position that it would not hold hearings on any patient without a current (within 21 days of the hearing date) progress note update from the Oregon State Hospital treating psychiatrist. That new policy initially resulted in more than 44 hearings being continued on the Board’s motion.
The other primary factor affecting this measure was the greater demand for hearings with only 65 budgeted hearing days on which to hold them. There is a limit to the number of full face-to-face hearings the Board can conduct in one day. The time it takes to hold a hearing varies widely depending on the client; the nature of the request; the number of witnesses; etc.

6. WHAT NEEDS TO BE DONE

Hospital staff have responded to the Board’s new policy so a decrease in continuances for that reason has already been noted by the Board and staff. However, an increase in budgeted hearing days would help with the other part of this problem. Further, staff will have to be even more mindful and somewhat ruthless in setting the docket with less regard to other considerations such as the short time an individual has been back in the hospital before a revocation hearing is held.

7. ABOUT THE DATA

The reporting cycle for this measure is the calendar year. However, the data is collected weekly and tallied on a quarterly basis from the calendar and computer reports generated that outline when each client’s particular hearing is due.

KPM #03 MAINTENANCE OF RELEASED CLIENTS
% of conditional releases maintained in the community per month Measure since: 1992
Goal To determine appropriate community placement and conditions of release so that a client is successfully reintegrated and public safety is maintained.
Oregon Context Agency mission and OBM #64 – Recidivism which may be impacted

Data source Agency records – revocation orders and monthly statistical reports
Owner Mary Claire Buckley, J.D., Executive Director – (503) 229-5596

1. OUR STRATEGY

The Board seeks to make appropriate decisions regarding community placement so that its clients remain on conditional release status and do not engage in criminal activity nor need to be returned to Oregon State Hospital.

2. ABOUT THE TARGETS

The Board lowered its target in this area due to the anticipated increase in the number of clients who would be on conditional release status this biennium. It was thought that with more clients in the community, it was likely that more revocations would occur which would reduce the number who stayed in the community. In this measure, the higher the number, the better the performance.

3. HOW WE ARE DOING

In 2005 the Board met its target and in 2006 the Board exceeded its target with an impressive 99% maintained.

4. HOW WE COMPARE

There are no relevant public or private industry standards related to this population with which to compare.
5. FACTORS AFFECTING RESULTS

Authorizing release to the community program and residential facility most fitting to a client’s needs is critical to the client’s success and the Board’s ability to meet its target in this area. Also continuous communication between the Board staff and treatment providers is essential. Community case managers must keep staff apprised of a client’s status so that the Board can intervene early in any difficulties that present themselves. The Board’s close supervision of its clients assists them to remain in the community. Access to alternatives to Oregon State Hospital such as residential alcohol and drug treatment programs or community hospitalization are an important resource for the Board to have available to reduce revocations.

6. WHAT NEEDS TO BE DONE

The Board and staff need to continue to provide whatever supports are necessary to maintain its clients in a community setting. This, in turn, requires DHS’ commitment to provide the financial resources necessary to access appropriate alternatives to State hospitalization.

7. ABOUT THE DATA

The reporting cycle is based on a calendar year. However, the data is collected and tallied on a quarterly basis from the revocation orders issued by the Board.

KPM #04 CUSTOMER SERVICE – % of customers rating their satisfaction with the agency’s customer service as “good” or “excellent”; overall customer service, timelines, accuracy, helpfulness, expertise and availability of information.
Measure since: NEW
Goal CUSTOMER SERVICE – To provide excellent customer service.
Oregon Context Agency Mission

Data source Results of survey of participants at Board’s Statewide training program
Owner Mary Claire Buckley, J.D., Executive Director – (503) 229-5596

1. OUR STRATEGY

To conduct a customer service survey to gain a sense of stakeholders’ satisfaction with the Board’s performance in the five listed domains. The Board will then review and act on the scores received.

2. ABOUT THE TARGETS

This is a new measure for the Board (baseline data has just been published in 2007) because only one survey has been conducted, we have not yet set targets on this initial data. Targets will be established as more data becomes available.
Higher percentages reflect higher satisfaction from our customers.

3. HOW WE ARE DOING

In 2006, 88% of respondents rated the Board’s quality of services as good or excellent. Given that this was the first attempt at surveying stakeholders, the Board had no idea what results to expect. There are certain categories – timeliness and availability of information which appear to need more focus by the agency so those percentages improve.

4. HOW WE COMPARE

There is no comparative data available.

5. FACTORS AFFECTING RESULTS

It is important to note the role the Psychiatric Security Review Board Plays in the lives of those responding to the survey. The Board is ultimately responsible for all decisions relating to a client’s placement, be it at the State hospital, in the community on conditional release or discharge.
As such, our customers, be it clients, hospital staff, community providers, persons in the criminal justice system, victims or members of the general public, often may not like the Board’s decisions, even if they are legally correct. This could affect the Board’s satisfaction ratings. Also our first survey did not reach a number of categories of stakeholders that should be solicited and did not include enough consumer/clients. This, too, is likely to affect the Board’s scores.

6. WHAT NEEDS TO BE DONE

The Board intends to broaden the spectrum of participants who receive its survey as well as engage in a greater effort to increase the response rate.
In the meantime, the Board will focus attention on the domains whose responses initially showed less satisfaction that others do so as to improve stakeholders’ opinions of the agency’s performance.

7. ABOUT THE DATA

The survey was conducted by agency staff in late 2006. It was sent to 168 individuals including Department of Human Services and Oregon State Hospital staff, community case managers, treatment and residential providers and consumers who had attended the Psychiatric Security Review Board’s two day statewide training program in the fall. We received 72 responses for a 43% response rate.
Results are retained by the agency and will be utilized by management to determine what actions should be undertaken to achieve improvement in certain areas.
The Board will conduct this type of survey on an annual basis from now on.

Contact: Mary Claire Buckley, J.D., Executive Director Phone: (503) 229-5596
Alternate: Phone:

The following questions indicate how performance measures and data are used for management and accountability purposes.
1 INCLUSIVITY
Describe the involvement of the following groups in the development of the agency’s performance measures. • Staff: As a small agency of 4 FTE, it was easy to involve staff in the process as all were literally at the table when our performance measures were initially developed in 1992. Since that time and throughout the modification of the performance measure system by the Progress Board, the Board and now 5 FTE staff have been engaged in the discussions related to the agency’s goals and what measures to utilize to demonstrate its performance.
• Elected Officials: Legislators’ provided input last Session by suggesting the removal of one measure from the external reporting process and utilizing it only for internal purposes.
• Stakeholders: Stakeholders’ opinions were solicited in meetings and individual conversations as well as to learn what they thought would be important to track and what outcomes they wanted the board to achieve.
• Citizens: The public as represented by the Legislature approved these performance measures during our budget hearing in the 2005 Legislative Assembly.
2 MANAGING FOR RESULTS
How are performance measures used for management of the agency? What changes have been made in the past year? Given that the Board’s primary purpose is to protect the public, the Board reviews the results to get a sense of the efficacy of its decision-making process at hearings.
The agency further assesses its monitoring function and compliance with its statutory mandates from this data. Depending on the results, the Board adjusts its procedures to improve the outcomes. Based on the results of the performance data collected, the agency has made efforts to improve outcomes in the areas where it fell significantly short of its target. In the past year the Board has increased the number of hearings scheduled per day to address the Board’s failure to provide hearings in a timely fashion for a significant percentage of clients.
3 STAFF TRAINING
What training has staff had in the past year on the practical value and use of performance measures? The Executive Director has attended the training sessions sponsored by D.A.S. and the Progress Board since the State implemented the performance measure system. She, in turn, shares the written materials received the other staff members and trains them in their use. Measures are calculated and reviewed quarterly to see what changes in operation might have to be implemented to improve measures that are wanting. Board members are also kept apprised as they recognize the value of performance measures in assessing the effectiveness of their work as well as areas of the agency’s functioning that might need additional resources when developing the Board’s budget.
4 COMMUNICATING RESULTS
How does the agency communicate performance results to each of the following audiences and for what purpose? • Staff: As noted above, staff review these measures quarterly to evaluate what operations might need to be adjusted to deal with any deficiencies that may be revealed. Board members are then informed as the adjustments usually affect their workload.
• Elected Officials: The Board communicates results to the Legislature through this Progress Board report as well as biannually in its budget preparation documents for review by the Department of Administrative Services , the Governor and ultimately by the Legislature and the public. The purpose would be to demonstrate how well the agency is carrying out its mission and statutory mandates.
• Stakeholders: The results are often cited in public testimony and presentations made by the Board and its Executive Director in various venues as well as at training seminars for all the various stakeholders in this system.
• Citizens: In citing the Board’s Key Performance Measure of recidivism and the percentage of those maintained on conditional release, the Board is often able to instill more confidence in a skeptical public and potential providers with these impressive figures when efforts are made to expand community resources and site residential facilities for P.S.R.B. clients.

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